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ARTICLES: Hannah B. Sahud, Helen J. Binns, William L. Meadow, and Robert R. Tanz Marketing Fast Food: Impact of Fast Food Restaurants in Children’s Hospitals Pediatrics 2006; 118: 2290-2297 [Abstract] [Full text] [PDF]

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A PRIME EXAMPLE OF USELESS "MEDICAL" RESEARCH

John J Ray   (20 December 2006)

Proof that using hospitals as a fast food marketing tool is successful

Joshua Wolf   (28 December 2006)

Why don't hospitals just provide GOOD food?

Victor C Strasburger   (2 January 2007)

Cafeterias and Fast Food Restaurants in Hospitals

Michele L. Jaffe, Ronald M. Davis   (20 January 2007)

A PRIME EXAMPLE OF USELESS "MEDICAL" RESEARCH 20 December 2006
John J Ray, psychologist retired Send letter to journal: Re: A PRIME EXAMPLE OF USELESS "MEDICAL" RESEARCH jonjayray{at}hotmail.com John J Ray	A PRIME EXAMPLE OF USELESS "MEDICAL" RESEARCH But the subtext of it is to demonize McDonalds. It took four medical researchers writing in a prestigious medical journal to establish such amazing facts as the fact that people eat more McDonalds in places that have a McDonalds restaurant! But such "authoritative" findings will be quoted in campaigns to get McDonalds out of hospitals, of course. The fact that for many people the McDonalds is the most comforting and reassuring part of a hospital does not matter, of course. The do-gooders must have a demon to attack. The above comment was also posted online here: http://john-ray.blogspot.com/ On Dec 20, 2006 Conflict of Interest: None declared
Proof that using hospitals as a fast food marketing tool is successful 28 December 2006
Joshua Wolf, Paediatric Fellow Royal Children's Hospital Send letter to journal: Re: Proof that using hospitals as a fast food marketing tool is successful joshuawolf{at}hotmail.com Joshua Wolf	Dr Ray's point is well taken. It seems obvious that the patients of a hospital will consume the food available there. The increased number of patients eating McDonalds food from hospital vendors is, however, not the real point of the article. His argument is a 'straw man'. What is exciting and interesting about this research is the documentation that people's impressions of the healthiness (or otherwise) of fast food is malignantly influenced by the presence of these restaurants in paediatric hospitals. The respondents from the hospital with an on-site McDonalds were twice as likely to think of MacDonalds food as healthier than the others. All doctors who work with children should be aware that McDonalds is not in fact healthy; it and similar food vendors contribute to the problems of obesity, hypertension and other diseases. This result is unsurprising. In fact, it is certain that the fast food industry has had similar unpublished data for many years. The concern is not what kids eat whilst at hospital, but their perception of the healthiness of a diet consisting of fast food! Sahud et al have proved that the linking of products such as McDonalds with paediatric hospitals is one which must be opposed by those interested in the health of children. Conflict of Interest: Employed by teaching hospital which has a McDonalds restaurant on premises.
Why don't hospitals just provide GOOD food? 2 January 2007
Victor C Strasburger, Professor of Pediatrics Univ of New Mexico School of Medicine Send letter to journal: Re: Why don't hospitals just provide GOOD food? vstrasburger{at}salud.unm.edu Victor C Strasburger	Of all places, hospitals should be the leaders in providing good, nutritious, healthy good, not fast food. Given that patients are "captive audiences" and that nourishing food might contribute to their speedy recoveries, shouldn't hospitals consider actually having top-flight chefs preparing food for patients? (I'm sure there are some that do already.) It has now been well documented that fast food restaurants have portion sizes that are way too big, people are unaware of the nutritional value (or lack of value) of what they are eating, there are too many promotional tie-ins with children's movies. What other information do we need to encourage children's hospitals to get out of the fast food business? By the way, the University of New Mexico Hospital has a Subway just outside its doors, not a burger joint! Conflict of Interest: None declared
Cafeterias and Fast Food Restaurants in Hospitals 20 January 2007
Michele L. Jaffe, physician University of Michigan, Ronald M. Davis Send letter to journal: Re: Cafeterias and Fast Food Restaurants in Hospitals mjaffe{at}umich.edu Michele L. Jaffe, et al.	Sahud, et al, reported that 29.5% of 200 hospitals with pediatric residencies had “fast food” restaurants on the premises.[1] In addition, having a McDonald’s restaurant in a hospital was associated with increased consumption of fast food by outpatients on the day of their visit and was associated with higher ratings of the healthiness of McDonald’s food. In November and December, 2005, we conducted an on-site observational survey of the cafeterias and restaurants in 21 hospitals in the Detroit area. We sampled hospitals from a list of hospitals maintained by the Michigan Health and Hospital Association (MHA) and from websites of corporations that owned more than one hospital in the Detroit metropolitan area (including the counties of Wayne, Oakland, Macomb, Monroe, Livingston, Washtenaw, and St. Clair). Hospitals were grouped by ownership, and at least one hospital in Detroit and one hospital in a jurisdiction outside Detroit per corporation were included in the sample. The 21 hospitals in our sample represented 53% of the 40 hospitals located in the counties mentioned above. Twelve (57%) of the 21 hospitals had pediatric inpatient or outpatient units on the premises and three (14%) had pediatric residencies. We collected information on the number and types of fast food restaurants in the hospitals and nutritional labeling of foods in the hospitals’ cafeterias. Five (23.8%) of the 21 hospitals in our sample had fast food restaurants on the premises – similar to the proportion reported by Sahud et al. However, two of the five were Subway restaurants, which have been recognized for offering and promoting low-fat sandwiches and providing some nutritional information on their menu boards.[2, 3] In the hospitals’ cafeterias surveyed, only 33% identified one or more healthy food options, only 14% indicated the nutritional content for two or more items prepared by the cafeteria, and none disclosed the nutritional content for all items prepared by the cafeteria. Only 19% of the hospital cafeterias promoted healthy options (for example, through signage), and none of the hospital cafeterias provided educational materials on healthy eating habits within the cafeteria. Sahud et al. conclude that “The presence of fast food restaurants in children’s hospitals should be reconsidered.” In our opinion, fast food restaurants should not be found on the premises of any hospital unless they meet strict nutritional criteria. Those criteria should include the provision of healthy food options; listing calories, saturated fat and trans fat, and sodium on menus or in brochures readily accessible to all patrons; and listing calories on menu boards.[4] Hospital cafeterias should maximize the provision of healthy food items while minimizing the availability of food items having poor nutritional quality. Some hospitals are moving in that direction,[5] but our survey and other surveys have shown that most hospitals fall far short of that ideal.[6, 7] In addition, hospital cafeterias should provide information to patients, staff, and visitors – on highly visible menu boards or in readily accessible brochures – concerning the calories and nutritional content of the foods and beverages being served or sold. Michele Jaffe, MD, MPH Clinical Assistant Professor University of Michigan Hospitals 9346 MSRB III 1150 W. Medical Center Drive Ann Arbor, Michigan 48109 Ronald M. Davis, MD Director Center for Health Promotion and Disease Prevention Henry Ford Health System One Ford Place, 5C Detroit, Michigan 48202-3450 1. Sahud HB, Binns HJ, Meadow WL, Tanz RR. Marketing fast food: impact of fast food in children’s hospitals. Pediatrics. 2006;118:2290- 2297. 2. Center for Science in the Public Interest. CSPI picks the best and worst fast foods (press release). August 21, 2002 http://www.cspinet.org/new/200208211.html 3. Jacobson M. McLabelling. Nutrition Action Healthletter. December 2005. page 2. cspinet.org/nah/12_05/cspinews_can.pdf 4. Center for Science in the Public Interest. Menu labeling at fast- food and other chain restaurants. http://www.cspinet.org/menulabeling/ (accessed December 27, 2006) 5. Landers SJ. Stepping up to the plate: hospitals move toward healthy eating. Amer Med News. January 29, 2006, pages 22-23. http://www.ama-assn.org/amednews/2006/01/02/hlsa0102.htm (accessed December 27, 2006) 6. Physicians Committee for Responsible Medicine. Healthy Hospital Food Initiative. September 2005. http://www.pcrm.org/health/reports/hospital_food05/intro.html (accessed December 27, 2006) 7. McDonald CM, Karamlou T, Wengle JG, Gibson J, McCrindle BW. Nutrition and exercise environment available to outpatients, visitors, and staff in children’s hospitals in Canada and the United States. Arch Ped Adolesc Med. 2006;160:900-905. Conflict of Interest: None declared

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